This is one of the last
books produced by the late and very lamented Roy Porter, perhaps the most
eminent scholar of his generation in the history of medicine, and psychiatry in
particular. It may not be the very last of course, because, as William Bynum
put it in his obituary, Porter seemed to write books at the speed that most of
us manage to read them.

Although Porter is only the co-editor the book bears
the hallmarks of his approach to scholarship. It is a collection of essays, in
this case papers developed from a workshop held in Amsterdam in June 2000
entitled Neurasthenia and Society, and is collaborative and wide-ranging,
interweaving themes and disciplines into a rich textured and layered approach,
as often as not a social history from below as one confronting grand
narratives. It consists of 16 chapters and a lengthy introduction, and moves
from the late eighteenth to the early twentieth century and considers the
cultural contexts of neurasthenia in America, Britain, Germany and the
Netherlands in particular. It is erudite and generous in approach, and gives
the contributors the opportunity to develop conference papers into extended
essays.

Although first introduced as
a term in 1856 by Robert Mayne in his Expository
Lexicon of Terms it was the American neurologist and electrotherapist
George Miller Beard who really popularized and promoted neurasthenia as an
explanation of, and reaction to a malaise of modernity. For Beard, neurasthenia
is not only archetypically American and modern, it was also an inevitable and
acceptable reaction to the fast pace of urban life and the psychological
dislocation it caused. Although the heyday of neurasthenia as a diagnosis may
have been in the early years of last century, and it may seem a historical
curiosity, the aetiological and explanatory ideas still preoccupy us today.
What is our relationship to modern culture, what does it do to our
psychological wellbeing, how do we relate to one another, what do we feel we
have lost? Why should this be and what does it tell us about ourselves? The
parallels that are explored through these essays indicate that, in many ways,
the more things change, the more they remain the same.

Neurasthenia was often
considered to be a disease of the elite. Perhaps of those who had the time and
the money to consider their world-weariness and to pay for the cure that often
required a stay in a health spa or sanatorium. The rich would be, as a matter
of course, be more highly developed and sensitive, perhaps like pure bred race
horses, while the poor, who may have demonstrated many of the same symptoms,
would be the donkeys of the world and be suffering more from the effects of
hard physical labour, sometimes in combination with the labour of childbirth as
well.

Tom Lutz in particular
considers the relation of neurasthenia to the more contemporary conditions that
characterize chronic fatigue syndrome. He also explores the acceptance of
organic or physiological explanations of the disorder compared with psychogenic
ones, and argues that this persists to the present day as an example of an
overdetermined desire to separate psyche and soma. This has treatment
consequences as well. As noted, Beard himself was an enthusiastic
electrotherapist, and the list of electric belts and vibrators and proprietary
cures make entertaining reading, but we should be aware of any hubris here. The
practice of hysterectomies and psychosurgery is not so far from our present
practice that we can afford to be smug.

One of the more interesting
themes, developed by a number of authors, is the contrast in the failing
popularity of neurasthenia in the mainstream culture in the West after World
War One, although there was a continuing taste for it in the treatment of
Veterans (although more so in America than elsewhere) and also in more recently
industrialized cultures such as China, Japan and Taiwan. Again, this is seen to
be as a result of a physiological explanation for the condition. Clearly, in
this model, the nerve weakness shown by battle fatigued soldiers could be
seen as extreme stress placed upon their nervous system and not any weakness of
the mind, and in newly industrialized countries could be seen as a mark of the
elite, after the fashion of America. However, the acceptance and use of
neurasthenia was not uniform, nor necessarily predictable. Opposite social
attributes, for example optimism and pessimism in fin de siecle Netherlands and Germany respectively, give rise to
the same observations of being popular or not. And vice versa.

There is also the gender
differentiation in diagnostic practice. Many more women than men were likely to
be diagnosed. Gynaecologists were particularly fond of the diagnosis, and it is
no coincidence that only the rich could afford them. There are not too many
cases of backstreet midwives recommended a rest cure in the mountains. The
explanation for this seems to lie in the underlying thesis of social
construction.

All the authors subscribe to
this position, and the way in which they marshal their arguments is impressive.
There are some distinct differences in styles and sometimes this can mean that
a close reading is required to note the ways in which the cultures differ in
their approach to and acceptance of neurasthenia as a diagnosis. Nevertheless,
although the simple premise that the different ways in which cultures account
for the same behaviours and attributes must be as a result of different
cultures and values is not new, but this volume adds to our understanding of
how and why that may come about. Neurasthenia may be a case of old wine in new
bottles, but as is pointed out, it was ever thus. The reaction of many British
physicians of the nineteenth century was just as it is today  a new fangled
term for an old problem. However, if the real point of history is to help to
explain ourselves to ourselves, this collection of essays makes a very
worthwhile contribution.

Dr
Mark Welch is currently a Senior Lecturer and Postgraduate Coordinator in The School of
Nursing at the University of Canberra, Australia. His PhD investigated the
representation of madness in popular film, and his other research interests
include the mental health of refugees and victims of torture, and the history
of psychiatric epistemology.